November 23, 2020

Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.

I want to give you two dates to put on your calendar.

Dec. 12 is the possible first day that the coronavirus vaccines could be administered in the United States. That is if the Food and Drug Administration and Centers for Disease Control and Prevention committees that approve vaccines clear Pfizer’s application for emergency approval for its vaccine.

The FDA set Dec. 10 as the day it would consider approval. Typically, after such approval, vaccinations can begin within a day or two, because it takes time to ship and organize the drugs.

The second date I want you to reserve is noon Eastern time on Dec. 14. I will be leading a live two-hour virtual Poynter workshop for journalists covering the vaccine effort.

I can confirm that among my guests will be the president of the American Medical Association, Dr. Susan R. Bailey, an immunologist. The AMA is partnering with Poynter to reach out to local journalists. We will also have other leading medical voices that I will be announcing soon.

Local journalists, we hope that you will consider this to be a news event you can record, cover and, to the extent possible, ask questions. The success or failure of the national vaccination program will depend a lot on local efforts. Stay tuned to this column for more information, but mark your calendar now, before you forget.

Who will get the vaccines first?

People are going to scramble to find a way to the front of the vaccine line. They may become frustrated by how the system chooses who gets vaccinated and who has to wait.

You may find that a wealthy, obese senior who never leaves home may be vaccinated before a poor, young Uber driver who is exposed to a lot of people each day.

People in jails and prisons will almost certainly get vaccines before many other people. University students may also get higher priority than factory workers since universities, like jails and prisons, have been COVID-19 hotspots. Senior citizens will get priority over children. Front-line medical workers and rescue workers will also get priority treatment.

But what about legislators and members of Congress? What about store clerks and farmers?

It will be important for the public to understand everybody will not be treated equally and why.

The Washington Post says:

In Britain, after vaccinating medical workers and nursing home residents, the government is leaning toward distributing the vaccine by age group — the over 80s, followed by over 75s, over 70s, over 65s — before extending it to other at-risk groups.

Philip Clarke, a health economist at the University of Oxford said, in Britain, some occupations were clearly more risky than others. “The first wave of the pandemic showed security guards and delivery drivers had worse mortality rates than health-care workers.”

Germany’s vaccine commission said shots should be given to people whose work in society fills “especially relevant functions and that aren’t easily replaceable.” Although many people think they are irreplaceable, Germany suggests these workers are public health officers, police, firefighters and teachers.

In China, officials want to include port workers, who provide the vital service of loading and unloading the cargo ships that power their trade.

Some countries are choosing to distribute vaccines not so much by age or population and instead plan to send the first vaccines to regions that are suffering the worst outbreaks.

The CDC has an “interim playbook” that suggests how the vaccines might be distributed in the U.S., but that is not the official final plan. That plan suggested these phases:

The word of the year will be announced today

Oxford Dictionary will announce its word of the year today. Is there any way the word of the year is not some form of coronavirus or COVID-19? How about something having to do with Black Lives Matter or the election? I am betting on “shelter in place” as the new phrase/word of the year.

The topic is so hotly debated that Oxford Languages published an entire explainer collection on it. It focuses on social media movements, remote work and learning and COVID-19.

Last year’s word was “climate emergency,” defined as a situation in which urgent action is required to avoid potentially irreversible environmental damage.

Watch the exciting announcement by registering here.

Nursing homes are in financial peril. 72% are in danger of closing.

Families of COVID-19 victims who passed away in New York nursing homes gather in front of Cobble Hill Heath Center. (AP Photo/Yuki Iwamura)

The American Health Care Association (which represents 14,000 nursing homes) recently reported that — at just the moment that COVID-19 cases are growing in nursing homes nationwide — the added costs of constant testing, new precautions and additional staffing are going to do one of two things: either force nursing homes to close or raise prices. This is a building emergency.

The American Health Care Association and National Center for Assisted Living found that more than half of nursing homes are currently operating at a loss and 72% of operators say they won’t be able to sustain operation another year at the current pace.

Genesis Healthcare, the largest nursing home owner in America, says low occupancy is a big problem, too. According to the Centers for Medicare and Medicaid Services, nursing home occupancy​ fell from 80.2% in December 2019 to 71.3%, where it has roughly remained since early September.

Look at this statement from Genesis CEO George V. Hager Jr.;

While we are grateful for federal and state financial support received and committed to date, the stimulus funds recognized in the third quarter of 2020 fell nearly $60 million short of the Company’s COVID-19 related costs and the estimated impact of lost revenue. Given the persistence of the virus, its intensification as we approach the winter months and the slow pace of recovery in occupancy, the Company remains reliant on adequate and timely government sponsored financial support to meet its obligations to patients, residents, caregivers and stakeholders.

In other words, the biggest nursing home company lost $60 million in just the last quarter despite federal help. Facilities in California, Colorado, Michigan, New Hampshire, New York and Rhode Island have announced permanent closures or have warned that closures are on the horizon.

AHCA/NCAL president and CEO Mark Parkinson recently told Skilled Nursing News, “If we don’t get assistance beyond that point, beyond the end of 2020 into 2021, that’s when you’re going to see that large percentage of buildings that say that they’re operating at a loss, that’s where you’re going to see potential closures.”

One nursing home in Muncie, Indiana, recorded 10 COVID-related deaths in a single day last week. That’s 10 deaths at a 108-bed facility. In one week, Southwestern Illinois nursing homes saw 341 COVID-19 cases.

The New York Times’ new calculation of nursing home deaths says more than a third of all COVID-19 deaths in the U.S. were nursing home patients. In 14 states, half of all COVID-19 deaths were related to nursing homes.

COVID-19 deaths linked to nursing homes (The New York Times)

The AHCA says that as COVID-19 cases spread around the country, nursing homes are noticing a nearly identical increase as the general population. Residents of long-term care facilities account for 8% of the nation’s cases, yet 40% of its deaths. It probably is not a surprise since so many residents have the dual risk factors of age and underlying health problems. But the death rate in nursing homes is not rising much as facilities get more experienced at spotting symptoms and reacting faster when cases arise.

(Centers for Medicare & Medicaid Services, May 31 – Nov. 1)

(Centers for Medicare & Medicaid Services, May 31 – Nov. 1)

(Centers for Medicare & Medicaid Services, May 31 – Nov. 1)

But a recent study by the U.S. Public Interest Research Group found that “one in five nursing homes were dangerously low on one or more items, like N95s and gloves.”

Parkinson is pleading with families to be especially careful this week if they choose to visit loved ones in nursing homes.

“We are especially concerned that this situation will only get worse with Thanksgiving just around the corner,” he said. “The public must realize that their actions not only endanger our nation’s most vulnerable, but also trigger government lockdowns of facilities, keeping these residents from their loved ones.”

Non-COVID nursing home deaths rise

The Associated Press dove into new data to see if there is something besides the pandemic behind a sharp rise in nursing home deaths.

As more than 97,000 of the nation’s long-term care residents have died in a pandemic that has pushed staffs to the limit, advocates for the elderly say a tandem wave of death separate from the virus has quietly claimed tens of thousands more, often because overburdened workers haven’t been able to give them the care they need.

Nursing home watchdogs are being flooded with reports of residents kept in soiled diapers so long their skin peeled off, left with bedsores that cut to the bone, and allowed to wither away in starvation or thirst.

Experts told the AP that in addition to routine care being stretched too thin, there may be an underlying mental health crisis in nursing homes that leads to deaths caused by what is vaguely termed “failure to thrive.” And the 15% spike in what analysts call “excess deaths,” meaning deaths beyond the figure normally expected, has been rising since March.

Families told the AP that because of the pandemic, they have been unable to visit loved ones living in nursing care. Any of you who has had a loved one in long-term care know, as I do, that family members are often the ones who raise important questions about care that overwhelmed workers may miss.

Trump ‘reannounces’ a drug order for a third time

President Donald Trump speaks during an event in the briefing room of the White House in Washington, Friday, Nov. 20, 2020, on prescription drug prices. (AP Photo/Susan Walsh)

President Donald Trump made a real live in-person appearance Friday to announce what was supposed to be a big money-saving drug plan. It wasn’t.

President Trump’s announcement about a drug plan that would cut drug prices is the same thing for which he signed an executive order in July, then rolled out again in September. It didn’t mean much then and now, with a couple of months before a new administration moves in, the proposed new rule almost certainly will be tied up in court until then.

The whole issue focused on what is called most favored nations rules, which means drug companies could only charge Medicare and Medicaid what they charge as their lowest price to anybody in the world. The president is correct when he says that drugs sold in the U.S. do sometimes cost more, sometimes a lot more, than elsewhere.

In July, the president’s plan only applied to a tiny number of physician-dispensed drugs, like cancer drugs. But in September, the president expanded his plan to virtually everything covered by Medicare, even over-the-counter meds. And then Friday, the president’s plan once again rolled back to just cover Part B prescriptions which, while being a small percentage of all Medicare-covered drugs, are some of the most expensive and with the fastest-rising costs.

The Pharmaceutical Research and Manufacturers of America opposed the plan in July, September and now.

President Trump also rolled out an idea to leapfrog normal procedures and pressed the Department of Health and Human Services to push through a rule that would require middlemen to pass drug rebates directly to patients. That was also something for which the president issued an executive order in July. This is how the White House explains the reasoning behind the rebate rule:

One of the reasons pharmaceutical drug prices in the United States are so high is because of the complex mix of payers and negotiators that often separates the consumer from the manufacturer in the drug-purchasing process. The result is that the prices patients see at the point-of-sale do not reflect the prices that the patient’s insurance companies, and middlemen hired by the insurance companies, actually pay for drugs. Instead, these middlemen — health plan sponsors and pharmacy benefit managers (PBMs) — negotiate significant discounts off of the list prices, sometimes up to 50 percent of the cost of the drug. Medicare patients, whose cost sharing is typically based on list prices, pay more than they should for drugs while the middlemen collect large “rebate” checks. These rebates are the functional equivalent of kickbacks and erode savings that could otherwise go to the Medicare patients taking those drugs. Yet currently, Federal regulations create a safe harbor for such discounts and preclude treating them as kickbacks under the law.

Could GOP-run states ignore votes and send electors to Trump?

Could states that Joe Biden won that have Republican-controlled state legislatures say “to heck with what the voters said, we are going to give the electors to Trump?” The answer is, probably, almost certainly, “no.”

Go back to the 12th Amendment, which gives states the authority to decide how electors would be chosen. The Constitution says, “Each state shall appoint, in such Manner as the Legislature thereof may direct, a Number of Electors.”

States wrote their own laws doing just that. As you know, every state except Nebraska and Maine decided the electors would be awarded in a  winner-take-all manner. For a legislature to change the rules, it would have to change the law. A legislature could do that for the next election, but it can’t change the law retroactively.

It is not just me saying that. Look at Article II Section 1, which says that very thing: “The Congress may determine the Time of chusing the Electors, and the Day on which they shall give their Votes; which Day shall be the same throughout the United States.” In other words, we chose the electors on Election Day.

There are two dates ahead in which probably nothing much will happen but you would circle on your calendar and pay attention to anyway:

Dec. 8: The “safe harbor deadline” for electoral college slates. This has been in place since 1887 and says if a state makes the “final determination” of its electoral college electors by that date, it “must be treated as ‘conclusive’ by Congress.” States that want to avoid any elector drama may take advantage of this.

Dec. 14: Electors meet at each state capital to sign a document. If there is drama, this is where it will be, but it is usually about as interesting as watching banks merge.

On Jan. 6, the vice president will read the documents from each state. Then, on Jan. 7, people living and working at the White House will scour liquor store dumpsters for discarded cardboard boxes to begin packing.

The way we live now

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Al Tompkins is one of America's most requested broadcast journalism and multimedia teachers and coaches. After nearly 30 years working as a reporter, photojournalist, producer,…
Al Tompkins

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